Saxagliptin has recently been approved for use by the United States Food and Drug Administration for the treatment of adults with type 2 diabetes mellitus in adjunct to diet and exercise and is now available in pharmacies. Saxagliptin is marketed by the tradename Onglyza? and is manufactured by Bristol-Myers Squibb and is being comarketed by AstraZeneca.

Saxapliptin is a dipeptidyl peptidase-IV inhibitor (DPP-IV) that works to lower glucoses by increasing the bodies Glucagon-Like Peptide-1 (GLP-1) level thus causing increased insulin production when glucose levels are elevated and reducing glucagon levels (a hormone that increases glucose concentrations). This medication is taken once daily and is available in 2.5 and 5 mg tablets. The most commonly used dose is 5 mg. The 2.5 mg dose is to be used in people with diminished kidney function or while taking certain others medications such as:

• Ketoconazole
• Atazanavir
• Clarithromycn
• Indinavir
• Itraconazole
• Nefazodone
• Nelfinavir
• Ritonavir
• Saquinavir
• Telithromycin

Studied as monotherapy and also in combination with Metformin, Glyburide, and Actos? or Avanidia? it has been shown to reduce HbA1c by values 0.5-0.8 beyond placebo and is effective in decreasing both fasting and 2 hour after eating glucoses.

The most common side effects compared to placebo are:

• Upper respiratory tract infections (7.7%, 7.6%)
• Headache (7.5%, 5.2%)
• Urinary tract infection (6.8%, 6.1%)

When the 5 mg dose was used in combination with Actos? or Avandia? there was a higher incidence of edema (swelling) when compared to placebo (8.1%, 4.3%). Hypoglycemia can occur in patients taking sulfonylureas such as:

• Glipizide
• Glimepiride
• Glyburide

Saxagliptin is NOT be used in people with type 1 diabetes mellitus and has not been studied in people taking insulin or in patients younger than 18 years old.

Onglyza? joins Januvia? (Sitagliptin) as the only other DPP-IV inhibitor available for use in the United States and seems to have a similar effectiveness, once daily dosing, and has not distinct advantages. Due to the potential drug interactions noted above providers, such as myself, may actually find this to be a disadvantage. Unfortunately, at the end of the day the decision to use one medication over the other will likely be driven by insurance carrier formularies versus individual provider preferences.

Galvus? (Vildagliptin) is a third DPP-VI inhibitor manufactured by Novartis that is available in Europe but not the United States due to the side effect of a potential rash and Alogliptin and Linagliptin are investigational DPP-IV inhibitors produced by Takeda Pharmaceuticals and Boehringer Ingelheim respectively.

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